Nursing environment linked to improved patient outcomes

Better working conditions and better staffing of nurses can significantly improve the care of patients with serious conditions, according to the latest nurse labor study by the University of Maryland School of Nursing.

Several troubling trends in patient outcomes surfaced as researchers analyzed survey data from 633 nurses in 71 hospitals in North Carolina and Illinois concerning patient outcomes, says lead investigator Alison Trinkoff, ScD, FAAN.

For example, pneumonia deaths were significantly more likely in hospitals where nurses reported increased psychological demands and more adverse work schedules. Trinkoff says they measured high psychological demands by very fast work, lack of time to complete work, excessive required work, being slowed by delays from other workers, and frequent interruptions. Another trend was that patients were more likely to develop deep vein thrombosis after surgery in hospitals where nurses reported high psychological demands. Staffing also was controlled in the analysis, so that the effects occurred independent of staffing.

"We selected outcomes that have been reported as nursing-sensitive and that have sufficient rates of occurrence to generate reporting data for over 90 percent of the hospitals," says Trinkoff.

The researchers calculated the association between job demands on nurses, both psychological and physical, and work schedule, against outcomes of patients with heart attacks, congestive heart failure, stroke, and surgeries that open a bone flap of the skull [craniotomy].

Also, they discovered that deaths from congestive heart failure were also significantly associated with long shifts and with nurses continuing to work while sick.

They found that deaths from heart attacks were associated with nurses frequently working with awkward postures and heavy weekly burdens.

Patients were more likely to experience postoperative hemorrhaging when their nurses were frequently interrupted.

And, where nurses reported a lack of time away from the job, patients were significantly more likely to develop respiratory failure and infections.

Not surprisingly, the demands, along with the schedules adversely affect nurses as reported in other studies as well. But this study showed that they can affect patient outcomes.

Positive aspects of the practice environment, such as peer and supervisor support, did not offset, or balance, the adverse impact of these demands.

Hospitals where nurses reported a focus on patient safety were less likely to have such complications or adverse patient outcomes of hospitals where patient safety was not a stated focus.